This is the final part in our series that examines at the corporal works of mercy through a feminist lens. Earlier posts considered homelessness, imprisonment, and poverty.
Traditionally, justice is defined as giving to each his or her due. Women have aimed to fight against injustice by demanding the equality that is due to them; however, many of the advances that we have made came with compromise, especially when it comes to women’s bodies and what only they can do. Rather than change “a man’s world” to carve out a space for women and their unique bodies, society has allowed women into that world by requiring them to behave and exist like men do. Abortion, birth control, lack of maternity leave, and inflexible work hours and environments are the byproducts of this compromise. Authentic justice demands that women’s bodies be recognized in their differences, which exist even down to the cellular level.
Authentic justice demands that women’s bodies be recognized in their differences, which exist even down to the cellular level.
It seems that the medical field should be the area in which the uniqueness of the female body is best acknowledged. After all, don’t all medical professionals study anatomy and physiology? However, gender bias and injustice dominate the medical field as much as they dominate other areas. Most, if not all, women have had a doctor who didn’t believe their concerns, dismissed or underplayed their symptoms, or even gave them a misdiagnosis. The real differences that distinguish male and female bodies must be incorporated into everything from medical textbooks and training to medical trials and treatment for patients. After all, do women not make up half of the world’s population?
In 2019, the Commonwealth Fund published a report comparing the state of U.S. of women’s health care in the United States with that of 10 other wealthy nations. The study found that, among other issues:
“Women in the U.S. are three times more likely to die in childbirth than those in Sweden and Norway and are more emotionally distressed than women in Germany or France. [The study] also found that nearly half of U.S. women report problems with their medical bills, compared with only 2 percent of women in the U.K.”
This Commonwealth Fund report is not the only source that identifies these issues. Women in the U.S. face the same difficulties as men do with insurance coverage, finding doctors covered by that insurance, and confusing and surprising medical bills. Furthermore, women also face gender-specific issues such as maternal mortality rates, gender bias regarding their symptoms, and underfunded research on the diseases most fatal to women. Ultimately, the Commonwealth Fund study found that women in the U.S. are more sick than their international counterparts, and they face a broken health care system that was not created to serve them. From medical research to mental and reproductive health, women are often viewed only in light of the male norm, rather than as bodies with their own genetic makeup.
Prior to the implementation of the Affordable Care Act (ACA), the Commonwealth Fund reports, “being a woman was, in effect, a preexisting condition and in most states insurers in the individual market charged women higher premiums than men.” The Fund’s 2012 report found that “almost 90 percent of plans in the individual market did not offer maternity coverage and only nine states required insurers to include this benefit.”
Things have changed in a positive direction under the ACA to prevent discrimination based on preexisting conditions (such as pregnancy), include free maternity and preventative services and guaranteed access to health coverage for most working-age women. The authors of the Commonwealth Fund does caution that “it’s important to remember that despite the gains made with the ACA, there are still women who don’t have access to any affordable health insurance options [...] there’s over a million American women like this, with no affordable options.”
Medical Research and Normative Male Studies
In her fascinating book Invisible Women: Data Bias in a World Designed for Men, Caroline Criado Perez explores how a variety of industries are constructed primarily with men in mind — including the medical and pharmaceutical industries. Perez begins by pointing out that for years, medical education has focused on “a male ‘norm,’” with everything that falls outside that “norm” being designated as “atypical” or even “abnormal” (84). She surveyed various medical school curriculums and textbooks and found minimal sex-specific instruction and sex-specific models portrayed in textbook diagrams.
Research shows that there are sex differences in every tissue and organ system in the human body, as well as in “the prevalence, course and severity of a majority of common human diseases” (Perez 85). In fact, every cell has a sex, meaning that men and women are different “down to the cellular and molecular levels.” These sex differences are also seen in immune responses to vaccines and drug metabolism.
If sex differences can be found in every human cell, and if they affect the body’s response to medication, it should follow that medical research and testing account for these differences. However, Perez found that women have been largely excluded from medical research because “female bodies are, it is argued, too complex, too variable, too constantly to be tested on” and, therefore, integrating them into this research is seen as burdensome (86). This view doesn’t just affect human subjects; it even influences studies on animals; only 12% of research focused on female-prevalent diseases have featured female animals.
Perez also addresses how the menstrual cycle impacts several kinds of treatment, including antihistamines, antibiotics, and heart medications. She points out that when women are tested in research studies, they are usually only tested in the early follicular phase in order to “avoid the impact of the hormones on study outcomes” (87).
Other issues specific to women’s bodies and experience that are left out of testing include pregnancy and breastfeeding, including the most recent COVID-19 vaccine trials. The exclusion of women from clinical trials and the viewpoint that women’s issues are not a high priority leads Perez to ask, “How many treatments have women missed out on because they had no effect on male cells on which they were exclusively tested?” (88). She can provide at least one example: There are five times as many studies on erectile dysfunction (ED) as there are on PMS. The priority of male issues led a drug originally created for period pain to become a drug for ED because it is often male-dominated panels that decide which drugs receive the funding they need to move forward.
In her Ted Talk, Dr. Paula Johnson summarizes this issue well, arguing that we are leaving women’s health care to chance in two significant ways: “We’re not making the investment in fully understanding the extent of these sex differences [in the cells]” and “We aren’t taking what we’ve learned [about those differences] and routinely applying it to clinical care.” Ultimately, this means that women are up to 75% more likely to have an adverse reaction to a drug treatment than men.
Women’s Experiences at the Doctor’s Office
It is not only drug trials and subsequent treatment that prevent women from receiving the health care they need. Often, simply the experience of going to the doctor leads to more stress, less help, or fewer answers for women. Perez reveals that women’s physical pain is far more likely to be dismissed as “emotional” or psychosomatic, leaving women to routinely wait longer than men for treatment (95). When it comes to common diseases or problems like heart attacks, women are also often misdiagnosed, because the usual list of symptoms tends to include what appears more in male patients.
Often, simply the experience of going to the doctor leads to more stress, less help, or fewer answers for women.
Dr. Johnson provides three examples in which the sex differences in cells impact the health of women. The No. 1 killer of women in the U.S. is heart disease, yet the differences in how it manifests in women is not included in the “gold standard tests” used for diagnosis. The primary symptom we associate with a heart attack is chest pain; however, in most women, a heart attack feels more like fatigue or indigestion, leaving many women undiagnosed and untreated for what is their most deadly disease.
Dr. Johnson’s second example is the top cancer killer of women in the U.S.: lung cancer. She explains that certain genes in lung tumor cells are activated by estrogen, making women who are non-smokers more likely to be diagnosed with lung cancer than non-smoker men and implying that treatment should take their hormonal makeup in mind. Lastly, Dr. Johnson points to depression, which is the No. 1 cause of disability for women in the world today. She states that “women are 70% more likely to experience depression over their lifetimes compared to men. And even with this high prevalence, women are misdiagnosed between 30-50% of the time.” Women’s symptoms of depression differ from men’s, and MRIs show that there are sex differences in the brain in areas connected with mood. Still, “66% of the brain research that begins in animals is done in either male animals or animals whose sex is not defined,” according to Dr. Johnson.
Aside from the lack of equal research into female symptoms and treatments, a gender bias pervades the medical community, resulting in unequal and inadequate treatment for many women. One reason may be that “physicians are still relying on longstanding research, clinical trials and medical training” that is based on “the body of your average white guy.” This bias judges “men [as] silent stoics [and] women [as] hysterical hypochondriacs.” As a result, men’s pain is often taken more seriously, while women’s pain is perceived as an overreaction.
Gender bias is also demonstrated by the fact that one in 10 women suffer from endometriosis, but it takes an average of seven to eight years to receive a diagnosis. When it comes to heart disease, women are more likely to be told to lose weight than to be put on preventative therapy.
Many women face other biases as well: poverty, race, and relationship status. This bias, a UPenn study found, resulted in a 16-minute longer wait for pain medication in an emergency room.
In her article for The Atlantic, Ashley Fetters summarizes women’s health care experience clearly:
“[Women] follow an ominous three-act structure, in which a woman expresses concern about [an] issue; the doctor demurs; later, after either an obstacle course of doctor visits or a nightmare scenario coming to life, a physician at last acknowledges her pain was real and present the whole time ... Women get prescribed less pain medication than men after identical procedures (controlling for body size), are less likely to be admitted to hospitals and receive stress tests when they complain of chest pain, and are significantly more likely than men to be ‘undertreated’ for pain by doctors.”
Maternal and Infant Mortality Rate
No issue is more specific to women’s bodies than pregnancy. It is no secret that the maternal infant mortality rate in the U.S. is high. In fact, in the last 30 years, the U.S. is the only developed country whose rate has been rising steadily. Between 700 to 900 women each year die from pregnancy-related complications in the U.S., while around 5,000 suffer from life-threatening complications. A recent Centers for Disease Control study found that two-thirds of the deaths were preventable. As with other issues, race significantly affects the maternal mortality rate. Black women are three to four times more likely to die in childbirth than white women, regardless of education, income, or other socioeconomic factors. Rates are also higher for women in poverty or who live in rural areas.
In the last 30 years, the U.S. is the only developed country whose maternal mortality rate has been rising steadily.
The Commonwealth Fund’s study identifies a number of factors that influence high maternal and infant mortality rates, such as inadequate access to preventive check-ups during pregnancy, high rates of caesarean sections (a risky procedure that is not necessary for most women), lack of prenatal care, and increased rates of chronic conditions (such as obesity, diabetes, and heart disease). Other reasons provided by a recent CDC study include the fact that new mothers are older than they used to be and have more complex medical histories, confusion about how to recognize worrisome symptoms, and poor information about what medical issues may arise for the mother (not just the baby) when discharged. For women in poverty, additional factors include a lack of time off or access to any kind of maternity leave, lack of child care support, and lack of health insurance to follow up on any postpartum issues.
Other Health Care Issues
A thorough dive into women’s health care issues would go well beyond the scope of this series, which aims to introduce how social injustices particularly affect women. However, there are a few other areas that we can address briefly to round out this look into women’s experiences with health care:
- Women are more likely to suffer from common mental health issues such as depression and anxiety. They are more likely to be dismissed as hysterical or diagnosed, yet they are also overmedicated. A great piece by Sophia Swinford dives further into this topic.
- Women’s health care is often limited to reproductive services such as birth control and abortion. Within this sphere, women are treated as a monolith, with every symptom treated or question answered with one pill rather than an individual diagnosis. Fertility awareness provides more authentic health care to properly diagnose and treat women as individuals. Other FemCatholic articles more directly address reproductive justice and fertility awareness through a feminist lens.
- Not only are women affected more when it comes to beginning of life issues, but they are also more affected when it comes to physician-assisted suicide.
- “Period poverty” is a public health crisis that affects many girls and women not only personally but also in the important areas of education and work. About every 28 days, women begin their period. This routine aspect of women’s physiology and biology has long been a point of discrimination for women, from the laws against “unclean” women (i.e., menstruating women) to the pink tax on women’s hygiene products.
Until women’s bodies are considered normative rather than “atypical” or “abnormal,” there cannot be justice in the medical field for women. True justice and reform should mean devoting equal amounts of time and resources to learning how women’s bodies function, how they react to treatments, and how diseases manifest in them. The call to visit the sick is not just about caring for people who are ill at home; it also includes fighting for and creating health care that treats the sick at all levels.
As Catholics, we ought to be pro-life from womb to tomb; unfortunately, many women face obstacles to caring for themselves from the time that they are conceived. To be truly pro-life, we must demand changes in how women experience birth, how they are treated when they are elderly or terminally ill, and at every stage in between — all in a way that respects how their bodies were created.
Next, we recommend you watch this talk inside the FemCatholic Community:
We have a right to understand our bodies and our health. And yet for far too long, women seeking understanding of their cycles, fertility challenges, and general reproductive healthcare have been dismissed, ignored, or simply given birth control as the first and often only line of defense. This talk explores the Black feminist theory of reproductive justice, explaining why Fertility Awareness Based Methods are vital to empowering women to not only make informed decisions about their healthcare, but also claiming their right to self-knowledge across the spectrum of their lives.